Transgender Status Not Linked to Increased Eating Disorder Symptomatology

transgender, gender dysphoria
The researchers’ goal was to assess eating disorder symptomatology in transgender populations as a function of gender affirmation (ie, hormone treatment or surgery) and health determinants (eg, anxiety, depression, and weight).

The following article is a part of conference coverage from the American Psychiatric Association Annual Meeting 2021, held virtually from May 1 to 3, 2021. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the APA 2021.


Eating disorders may be overdiagnosed among the transgender community. These findings were presented during the American Psychiatric Association annual meeting held virtually May 1 to 3, 2021.

Patients (N=166) who were transgender were assessed between 2017 and 2018 by the General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Eating Disorder Examination Questionnaire (EDE-Q).

Of the patients, 52.4% were transgender women with a mean age of 31.11±13.05 years, 71.1% were White, their mean body mass index was 30.05±8.91 kg/m2, 68.7% were hormone-experienced, and 18.1% had undergone gender-affirming surgery.

On average, the patients indicated they had mild anxiety (GAD-7, 5.61±4.93) and mild depression (PHQ-9, 5.92±5.59). Few (13.9%) had a past eating disorder diagnosis.

EDE-Q scores were similar to sample norms from the cisgender community with shape concerns as the highest subscore (mean, 2.42±1.60).

Transgender women reported significantly higher EDE-Q scores compared with transgender men (mean, 1.62±1.28 vs 1.30±1.11; P =.039).

Patients who had surgery and were hormone experienced had lower EDE-Q scores (mean, 1.08±1.02) than patients who had not had surgery but were hormone experienced (mean, 1.68±1.30; P =.051) and had significantly lower shape concern subscores (mean, 1.78±1.26 vs 2.66±1.70; P =.029).

These observations contradicted previously reported EDE-Q scores among transmen, in which this study found significantly lower global (mean, 1.30±1.11 vs 1.73±1.28; P =.006), restraint (mean, 0.84±1.27 vs 1.33±1.42; P =.006), eating concern (mean, 0.45±0.79 vs 0.87±1.19; P <.001), and weight concern (mean, 1.62±1.46 vs 2.06±1.61; P =.038) EDE-Q scores.

This study was limited by the low sample size. Additional higher-powered studies are needed to assess whether these findings are generalizable to the entire transgender community.

Despite previous evidence from cross-sectional studies and case reports that suggested eating disorder psychopathology was more prevalent among the transgender community, these data suggested the transgender population did not have higher EDE-Q scores compared with the cisgender population. There appeared to be a trend for eating disorder psychopathology to decrease following gender-reaffirming surgical procedures.

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Choi Y, Nowaskie DZ, Filipowicz AT. Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation. Poster presented at: APA 2021: May 1-3, 2021. Abstract/Poster 4653.